Wednesday, August 10, 2011

He was sitting upright in his treatment cot as I walked into Room 28, his three-year-old eyes turned upwards and focused on the blaring nine-inch corner TV. His young parents, barely in their early twenties, stood to the left of their son's cot, their eyes fluttering between me, the TV, and their son. Within seconds, all three sets of eyes had settled on me, the stranger who had just invaded their privacy. I smiled at them. Before introducing myself, however, I walked up to the TV and turned it off, appreciating the sudden disappearance of Sponge bob and the arrival of a much quieter, calmer room.

I held out my hand first to the little boy. Because of his age, it was only appropriate that he first look to his mother and father for approval before taking it. They approved, after taking in the stethoscope around my neck. "Hey buddy," I said, taking in this little guy's appearance while I grasped his small hand, "I'm Dr. Jim. It sure is nice to meet you!" He smiled shyly as I shook his hand with exaggeration. Next, I focused on the patient's parents, holding out my hand to each and shaking their's warmly.

All the while, I focused on the appearance of this patient and his parents. The patient was healthy- appearing for his age, existing in that stage of healthy-chunky and thinning-out, his cheeks no longer swollen lumps of baby fat. He wore pajamas, littered with small holes and sprinkled with stains of various fruit juices. His face was smudged. His teeth were discouraging, little decaying flecks of brown. His arms and legs needed a good scrubbing. Underneath his nails, I could appreciate the fine-line of brown that would require a bar of soap and a good brushing to make clean again. His hair was slightly matted and blondish-brown, the subtle curls poking several strands in an unexplainable pattern.

Yet, he smiled. Big and beautiful, innocent and endearing. Bad teeth and all. He smiled at me. He smiled at his parents. He smiled at the nurse who came in to check on him while I was in the room.

The parents, she taller than he, paced beside the cot. She was the talker, he the backer-upper. With every question I asked, she would answer it first with a concise answer, sometimes being quite insightful. He would listen to her answer and then, like a well-oiled machine, add "Yeah." Nothing more and nothing less. They both, like their son, wore clothes that were scrappy and stained, well past the normal point of a necessary washing. Their hair, his short and brown and her's long and blond, was oily. Upon smiling at me during introductions, I noticed the same teeth as what their son had. Plaque build-up was very evident from my close stance. I imagined them to be chocolate Chiclets, if there was such a flavor of Chiclets, fragmented from being dropped to the ground. Their exposed skin, that not covered by their t-shirts and shorts, had a sheen of grime.

Yet, they smiled. Just like their son.

I sat on the foot of the cot, facing the parents. "What," I asked them, "may I do to help you out with Joshua today?"

The mother moved from her standing spot along the counter to the head of the bed, where she held the back of her hand to Joshua's forehead. She turned her hand and held her palm to Joshua's cheek, letting it linger there for a while, the way a mother's hand should linger when touching her child.

"We were so worried, Doctor," she said, her smile dissipating and her face gaining an anxious quality, "about Joshua's fever. It wouldn't come down for us."

"Yeah," added her husband.

She continued, her voice quivering slightly. "It's been about three days of sweating and chills and high fevers for Joshua. We just don't know what to do anymore."

"Yeah," added Joshua's father, his eyes darting from Joshua to his wife to me.

After a little more talking, I discovered that she had been under-dosing Joshua's acetaminophen and had not been aware she could use concurrent ibuprofen intermittently. The nurse had educated both mom and dad, in triage, to Joshua's proper dose after she had recorded a temperature of 103.4 F. As a result, I was now examining a child who was smiling and had broken his fever. And despite his slovenly appearance, this was one cute kid who appeared to be very happy and very loved.

Sometimes, a three-year-old boy can make for a very difficult exam but, in Joshua's case, he could not have been a better patient. Whether it was the fever breaking, his starting to eat and drink again, or just his baseline personality of unadulterated happiness, he was a pleasure to treat. Thankfully, he appeared quite stable despite having bilateral ear infections (acute otitis media). What could have been a very serious illness turned out to be something less that could be treated with high-dose amoxicillin. In addition to good fluid intake and proper use of acetaminophen and ibuprofen, I expected Joshua to be back to his normal self in a few short days.

Typically, after treating a child with ear infections and having a thorough conversation with the parent(s), I would race to fill out the appropriate chart paperwork, including prescriptions and discharge instructions. With Joshua and his family, though, things were different. This was a patient who made me reevaluate my first impressions. Because although Joshua and his family were indigent and struggling with proper hygiene and material things, never once did I doubt his parents' love for him. They sat with him on his cot. They played with him. They helped me coax Joshua to open his mouth so I could visualize his throat. They held him over their shoulder so I could listen to his lungs more clearly.

They did everything, with ease, that I look for to make sure a child is safe and loved.

I guess love comes in many forms. Part of my love for my children includes that they be clean, dressed appropriately, be respectful, and learn from an early age to appreciate good hygiene. Although, truth be told, my wife and I shower our kids with the more important stuff--lots and lots of unconditional love. That kind of love outweighs all. Whether for financial reasons or lack of knowledge, or maybe for reasons I simply didn't uncover, Joshua's parents seemed to struggle with certain learned parental roles. What they did endorse, however, was to show their son patience, concern, worry, and happiness. And love. Lots of unconditional love.

I talked to them a bit. They had an apartment, although they struggled to make financial ends meet. They both came from broken homes. "I don't know what a good mother should be like," the mother said with honest introspection. "Yeah," added her husband. I assured them that they already seemed to have mastered the most important part of parenting, by giving their child unlimited love and attention, but there were other ways they could improve Joshua's life. Because they wanted the world to be Joshua's, they were willing to do whatever that might take. Thus, I called social services to have them follow Joshua's family. Maybe find some parenting classes. Give suggestions for whatever they may need. Basically, just bring their attention to more of the learned parenting skills.

Later on in my shift, I was fortunate to take care of another child, this one dressed well in designer clothes, clean, with perfect four-year-old baby teeth. Uppity parents. Unfortunately, this child and his family had nothing on Joshua and his family. Not...a...thing.

Sometimes, I gotta love my job and the cool people I get to meet.

As always, big thanks for reading. I hope this finds you well and your summer going smoothly. We are vacationing in the New England states and enjoying every minute of our family time. Soon, the posts will become much more regular (as soon as the writing rust wears off)...

I so relate to this, gives me some insight into why doctors seem to get an attitude with me pretty quickly when i ask why they turned off the TV show my child was watching.That and being clean and neat, being able to speak in complete sentences and ask challenging questions. I always thought that annoyed the doctors, now I know.

I hope you continue to follow him. Was it social services or child protective services you called? You have to be very careful with that. They will take children with little reason and not give them back, and they might find his bad teeth reason enough to take him. I really hope you continue to follow them. Child protective services has a tendency to take the child first, and forget to ask questions later. I haven't lost a child myself, but my nephew did. And, I've read many many horror stories about parents not being able to get their children back while researching ways to help get him out of foster care.

I love the kindness and empathy that surges out of the posts you write.

Recently my 20 Something daughter and I went to see a documentary together. It was about a man named Buck Brannaman who is a horse trainer by trade. One of the (many)things that caught my attention was a brief view of him working with his youngest daughter before his clinic started. Riata, who was probably 16 or 17, was on a colt she was starting and he was helping her. The enjoyment he got from being with his daughter, doing something they both love, came through with the quiet laughter and the jokes they shared. Too often we don't see parents who appreciate their kids, we see parents who are impatient, with just-below-the-surface-anger. It is tremendously refreshing to see parents like Buck or Joshua's who are open to suggestions and so obviously love that child.

Glad to hear you're enjoying your vacation and that posts will be coming more regularly. ;-) I made it home safely, too. In the grips of a cold and jet lag... but alive and well, all things considered.

Just yesterday I was thinking and blog commenting about some kids I met in Guatemala a few years back. They had broken Barbies, beans for meals, and blankets that wouldn't keep me warm... but you wouldn't find them complaining. They had joy beyond anything we could imagine!

I think it was so important that you reinforced their positive input into their son. No doubt they get judged because of their appearance and people miss what IS most important. Just as with the last family you mentioned.

you can have everything ...but without love and respect ...what do you really have?

Hygiene is obviously so important. Perhaps they just need that guidance and someone championing their efforts ..a mentor of sorts. I'll be honest. I don't know why hygiene would not be an obvious thing. I know people can't afford dental ...but you can brush your teeth, etc.

Culture they came up in? Depression? It just seems so basic. A bar of soap? Hopefully, just as you hoped ..they have improved in that area.

I remember some patients coming into the ER and the kids were as you described, but the parents were atrocious and spoke to them in ways that made me CRINGE. Whenever I could, I would be supportive of the child (politely), but reinforce something positive about them.

I remember one child looked up at me incredulously and his parents stopped in their tracks. he seemed surprised, but appreciative of my kind words (rescuing him from parent's verbal abuse)and his parents were taken aback and shut up.

The boy you describe has a good chance in life. I often wondered about the kids from the types of family where they lived in bad environments ..seemingly low parental IQs (definitely socially), verbal abuse and generational welfare mentality.

Your story reminds me of a paper I wrote titled "Do the clothes really matter?" You have shown that they don't...or maybe they do...but in a very different way. I'm glad you recognized that the child's appearance wasn't due to lack of love but rather lack of knowledge and education on the parents part....with the assistance of the social worker I am confident the parents will endeavour to provide for their child to the best of their abilities!

You are a very kind and compassionate doctor. I only hope the social services you contacted will see beyond the poor teeth and lack of being squeaky clean and see the love these young parents have for their child. Not everyone sees past the outward appearance.

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About Me

I am a father of three. I am an ER physician of 16 years. I am a son, a brother, an uncle, a cousin, a nephew, and a friend, always. I am an athlete. I am small-town. I live in a big town. I am from a large, forestry family. I miss my mother's voice. I enjoy life's simpler, mundane moments. I am humbled daily. I am privileged with many blessings in my life. I am a writer.

Disclaimer

The events and encounters described in this blog are for general discussion and amusement only. They should be considered fiction. Nothing written here should be constituted as medical advice. Although the events of this blog contain certain elemental truths, every attempt has been made to protect patient confidentiality. Names, dates, location, and identifying features have been changed or fictionalized for that reason. The author reserves the right to embellish to make a good story great. All opinions expressed herein are those of the author only. All content is copyright of the author. Please do not reproduce or copy in part or whole without his expressed permission.